Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2012 00328
T ( G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S 108AB05100
Jurisdiction: Tigard
Site address: 14087 SW 155TH TER
Project: Lee Subdivision: BRENTWOOD ESTATES Lot: 13
Project Description: (2) gas furnaces, (1) generator and gasline
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: JACOBS
4474 SE MILWAUKIE 14087 SW 155TH TERR
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/27/2012 $93.50
Type of Use: SF Other, Heating /Cooling 06/27/2012 $23.32
Class of Work: ALT Type of Const: Fuel Piping 06/27/2012 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 06/27/2012 $15.72
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $146.69
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /�
Issued By: 4jP Lg t Permittee Signature: D A PPL t.i , &.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. ,
Mechanical Permit Application FOR oir ic c. L SI. O1.1
City of Tigard C WEE D Iteocived
Dats/By: Permit No. 6& . 00 a.
IN 4 . . .
13125 SW Ball Blvd., Tigard, it.F742 Plan Review/
III Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other Penni • ,•• O. • Ot, ,
• 1 1 ,-_, , \ t< 0 Inspection Line: 503.639.4175 juN 2 5 2(112
Date Ready/By; 11211 El See Page 2 tor • •
Internet: www.tigard-or.gov Notified/Nlethod. Suppbsnental Information
task. A F ARD
1 , r .. etv-imrrit, ,
----- 4'" '" , ii 4
IV . - Mechanical permit fees* ere based on the value of the work
181 New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other. . mechanical materials, equipment, labor, overhead, and profit
Value: $
' p, i' ' , , :-. ...e.2:.: , z,:. ' -4. •:. -..• , .: • • , 1 p..,,,,,: , .L.,....,,,!..;, 0 k.a. Iii.,,s-'
■
\ El 1- and 2-family dwelling 0 Commercial/industrial 9 Accessory building For 'pedal Information use checklist.
0 Multi-family El Master builder 0 Other. Description I Qty. I Ea. II Total
7.,.:;/4VF, '1 " RiF - I - FtIrc:T,Irorr4' , 'YiT
. ‘ 2 "LLP '- ''''''''''' -""I ' 1.1 " 47 ) 1 / 71/ r. 111 •4 7 '''.' 3L 'Alkettails13...":i 4 Nr'E',t , : ,•,,,, :•iot ,
Air conditioning
Job site address: 14087 SW 155 Terrace (requires site plan showing placement) 46.75
City/State/ZIP: Tigard OR 97202 - Furnace 100.000 BTU (ducts/vents) 2 46.75 93.50
Furnace 100,000+ EITIJ (dnota/ven03) 54.91
Suite/bldg./apt. no.: Project name: LEE Heat pump
,
(requires siteplmi allowing placement) 61.06
Cross street/directions to job site: Duct work 23:32
Hydronic hot water system. 2132
• Residential boiler (radiator or •
hydronic) 2332
Unit heaters (fuel-type, not electric),
• .
in-wall, in-duccauspencled, etc. 46.75
Subdivision 1 '
I Lot no.: Flue/vent for any of above 2132
Other Generator 1 23.32 . 1 23.32
Tax map/parcel no.: Other fuel appliances:
• •F. .'.3 Water heater 23.32
:;2migniksn.73s2gadirvsn:41-
Gas fireplace/insert 33.39
2 gas furnaces, 1 generator and a gasline
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
' Wood fireplacermsen 23.32
f .
• : "NI l''''' '2' ChlioneY/liocrlflueivent 23.32 •
23.32
Name: • Environmental exhaust and ventilation: .
Address: , Range hood/other kitchen
• equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) Fax ( ) ,toilet compartments, utility moms) 23.32 '
. Athekrawlipace Sins 23.32
'''".:::.-A;1::',;Q:::;1111L..d::tei , fr; 4 4 ' "l'il.! hr'■••• ..4 !: - . 1 /1•'.111■L' .1/ 1 1■2c.j..430,ZZ . bfUlle 662Mtille ;'
Other 23.32
Business name: ..
Fuel piping:
Contact name: $14.15 for first foar; $4.03 for each additional
• Address: Furnace, etc.
Gas heat plump 1 14.15 14.15
• City/State/Z1F: Wall/suspended/unit heater
Phone: ( ) I : ( ) Water heater
Fireplace - _
E-mail: Range
' r=, :7:44Vir..": ', .:',.,5.:'1'g.C.'■;;;;g Barbecue
.- , ....z.-.-.,,I;r.L4-1. !I. •:••
Business name: Jacobs Heating and air conditioning Clothes di m (
Other.
Address: 4474 SE Miwaulde Ave . r'il . '".'''.':';=::::-. 1 ::Z.1-',E':' - fleLitz'''',,li9J1T.t 5 ,1T , !17.Fn c ti:"P i ::i7-"4"4 3 :'44.
• ,, -;,- ,, o.i., ,..1.r,i,N.,;.b.,...:... 4 ...z..i.........,..1:..7..^-
City/StattJZIP: Portland OR 97202 _ _ Subtotal 130.97
Minimum permit fee (590.00)
Phone: (503) 234-7331 I Fax: (503) 81.3-9258
/ Plan review (25% of permit fee) •
V COB lie.: 1441 4
/ - State surcharge (12% of permit fee) 15.71
TOTAL PEIthffr FEE 146.68 4 .-- ----
.
. -. - This permit application expires If a permit Is not obtained within 180
uthorized stgnature STA
A 0 , 41 days after tt has been accepted as complete. Of '
I Print name: Corinna • Mc I Date: 6/25/12 I • Fee methodology set by Tri-C-ounty Building Inchon, Service Board
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